Guignard J P, Gouyon J B
Service de Pédiatrie, Centre Hospitalier Universitaire Vaudois, Lausanne, Suisse.
Biol Neonate. 1988;53(4):243-52. doi: 10.1159/000242797.
The immature kidney may be adversely affected by a variety of vasoactive or diuretic drugs, either administered to the mother during pregnancy, or to the neonate. Inhibitors of the angiotensin-converting enzyme administered to the hypertensive pregnant woman can severely and sometimes definitely impair renal function in the fetus, leading to postnatal anuria. Pathogenesis involves interference with the renin-angiotensin system and the prostaglandins. Beta-adrenergic agents administered during labor depress glomerular filtration rate transiently. Tolazoline, an alpha-adrenergic blocking agent useful in the treatment of persistent pulmonary hypertension of the neonate induces intense renal vasoconstriction with consequent hypoperfusion. Indomethacin, a prostaglandin synthetase inhibitor used for the pharmacological closure of a patent ductus arteriosus, also increases renal vascular resistance, and decreases urine output. Furosemide, the drug most often used in oliguric neonates, may also adversely affect the newborn infant. Its use has been associated with an increase in the incidence of patent ductus arteriosus, hypercalciuria, nephrocalcinosis and secondary hyperparathyroidism. These observations demonstrate that the proper use of drugs requires that the therapeutic endpoint be clearly defined and the predictable side effects be anticipated.
未成熟的肾脏可能会受到多种血管活性药物或利尿剂的不利影响，这些药物要么是在孕期给予母亲，要么是给予新生儿。给患有高血压的孕妇使用血管紧张素转换酶抑制剂，可能会严重且有时肯定会损害胎儿的肾功能，导致出生后无尿。发病机制涉及对肾素 - 血管紧张素系统和前列腺素的干扰。分娩期间使用的β - 肾上腺素能药物会短暂降低肾小球滤过率。妥拉唑啉是一种用于治疗新生儿持续性肺动脉高压的α - 肾上腺素能阻滞剂，可引起强烈的肾血管收缩，进而导致灌注不足。吲哚美辛是一种用于药物性关闭动脉导管未闭的前列腺素合成酶抑制剂，它也会增加肾血管阻力，并减少尿量。速尿是少尿新生儿最常用的药物，也可能对新生儿产生不利影响。其使用与动脉导管未闭、高钙尿症、肾钙质沉着症和继发性甲状旁腺功能亢进的发生率增加有关。这些观察结果表明，正确使用药物需要明确定义治疗终点并预测可能出现的副作用。
